Daily ReCAP March 9, 2017

Chronic: Many Patients with Chronic Lung Diseases Use Inhalers Incorrectly

Many patients with asthma, chronic obstructive pulmonary disease, and other chronic lung diseases are using their inhalers incorrectly, resulting in somewhere between 7% and 40% of drugs being delivered to the lungs, according to results from recent studies. Errors are common in inhaler use because it requires precision, timing, and coordination, according to investigators. Even the slightest deviation can significantly reduce the amount of medicine that reaches the lungs. The results of 2 studies that sought to find which mistakes were most common found that patients made at least 1 mistake as much as 70% to 90% of the time. Study co-author Rajoshi Biswas said, “The thing that matters the most is coordination. It’s vital to start breathing just before or at the exact same time the inhaler is activated. A delay of just a half second between pressing the inhaler and breathing in was enough to limit lung deposition to about 20%—–about half of what a patient would get in the ideal case.” The results of the study differed from those of the current Global Initiative for Asthma inhaler use guidelines, because in recent years, the propellant used in inhalers changed. Unfortunately, the guidelines were developed based on studies using old inhalers, suggesting the need to update them and set up educational strategies for patients.

Acute: Little Benefit Seen From Low-Intensity Pulsed Ultrasound for Fracture Healing

Low-intensity pulsed ultrasound (LIPUS) has been used for more than 2 decades as an adjunct treatment to improve bone healing, but a recent study found that it does not improve outcomes and probably has no effect on radiographic bone healing. In a study published inBMJ, investigators found that LIPUS did not reduce time to return to work or the number of subsequent operations. Regarding pain, days to weight bearing, and radiographic healing, the effect varied substantially among studies. Trials at low risk of bias failed to show a benefit with LIPUS, whereas trials at high risk of bias suggested a benefit. When only trials at low risk of bias were considered, LIPUS did not reduce days to weight bearing, pain at 4 to 6 weeks, and days to radiographic healing. “Moderate-to-high quality evidence shows that LIPUS fails to accelerate return to work, return to full weight bearing, and pain reduction or reduce the need for subsequent operation,” the authors concluded.

Preventive: Resveratrol Protects Against Spinal Cord Injury

Resveratrol could protect against spinal cord injury, a study published inPubMedsuggests. In prior research, resveratrol has exhibited neuroprotective effects in many neurodegenerative diseases, but the effect and mechanism on spinal cord injury was unclear. Using the spinal cord of injured rats, investigators found that primary neurons treated with resveratrol alone or in combination with AMPK inhibitor Compound C or SIRT1 inhibitor EX527 showed that treatment with the inhibitors blocked the increase in LC3-B expression. The findings suggest that resveratrol exerts neuroprotective effects on spinal cord injury by regulating autophagy and apoptosis mediated by the SIRT1-AMPK signaling pathway, the authors concluded.